Sodium Bicarb

[Auk001]

Could someone explain on a cellular level/ patho level why pushing sodium bicarb in a code situation, keeps the blood pressure up temporarily????:yeah:

[CNL2B]

From wikipedia, searched "sodium bicarbonate". You can usually find your own answers to this pathophys stuff if you look. It's the "what would you do in this situation" that allnurses is valuable for. FYI it is not the bicarb persay that brings the B/P up. Extreme acidosis means nothing works --- your cells don't function. So if you can buffer the acidosis a little bit with some bicarb, your cells can start working again and maybe use some of that circulating epi, dopamine, etc.

"Sodium bicarbonate is used in an aqueous solution as an antacid taken orally to treat acid indigestion and heartburn.[8] It may also be used in an oral form to treat chronic forms of metabolic acidosis such as chronic renal failure and renal tubular acidosis. Sodium bicarbonate may also be useful in urinary alkalinization for the treatment of aspirin overdose and uric acid renal stones.

An aqueous solution is sometimes administered intravenously for cases of acidosis, or when there are insufficient sodium or bicarbonate ions in the blood.[9] In cases of respiratory acidosis, the infused bicarbonate ion drives the carbonic acid/bicarbonate buffer of plasma to the left and, thus, raises the pH. It is for this reason that sodium bicarbonate is used in medically supervised cardiopulmonary resuscitation. Infusion of bicarbonate is indicated only when the blood pH is marked ([10]"

[TangoLima]

I noticed this is a code situation as well. I also noticed that the HR increases when the bicarb is pushed. So, I had a nice conversation with another very experienced nurse afterward. Basically, in an acidotic situation, the cardiac cells lose their action potential, so the cells cannot contract and produce a beat. When bicarb is administered, the action potential is restored, and the heart is able to contract as it should, hence the increased HR. I am guessing this is partially explains the increased BP you noticed as well. The heart is actually doing it's job, cardiac output is increased, and therefore BP increases as well. At least this is how I understood it.

I am relatively new to the ICU so I am seeing so much that I really have to stop and think about what is going on cellularly. Fun stuff!